Maternal health services utilization and maternal mortality in China: a longitudinal study from 2009 to 2016

Abstract

Background: The Chinese government introduced the maternal health services as part of the Basic Public Health Service (BPHS) project in 2009. While China has made progress in reducing maternal mortality, the longitudinal association between the utilization rate of the maternal health services of the BPHS project and such reduction was rarely evaluated with robust methods. Methods: We conducted a longitudinal study on the maternal health service utilization rates of the BPHS project and the maternal mortality ratios (MMR) in mainland China and its 31 provincial regions. The data were extracted from the National Health Statistic Yearbooks (2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016). Panel data models were used to evaluate the association between the utilization rate and the MMR after adjusting for available covariates on healthcare resources. Stepwise regression models were used to gauge the direction and magnitude of omitted variable bias. Results: It was found that the service utilization rate increased from 79.24% in 2009 to 91.67% in 2016, while MMR decreased from 30.90 to 17.88 per 100,000 livebirths at the national level. The results of the fixed effects panel data model revealed that the utilization rate was associated with MMR deduction continuously. With every 1% increase in utilization rate, the maternal death would decrease by 0.35 per 100,000 livebirths after having the health resources variables adjusted. Conclusions: The utilization of maternal health services increased continuously after the introduction of BPHS project in 2009 and MMR went downward from then on. The utilization of maternal health services did have significant association with MMR and could reduce MMR effectively. Such improvement could be attributed to the fact that this program was designed to serve the targeted population throughout the continuum of maternal care and the government's rigorous efforts in stressing equality and standard care in program implementation.

Maternal healthcare utilsation and complete childhood vaccination in sub-Saharan Africa: a cross-sectional study of 29 nationally representative surveys

“…Maternal healthcare and childhood vaccination are major public health issues in sub-Saharan Africa (SSA) and the international community has prioritised them by integrating them into the Sustainable Development Goals (SDGs). [1][2][3] Maternal healthcare services are regarded as essential because they are not only required to improve and promote women's reproductive health but also needed to reduce maternal and child mortality. 4 Effective utilisation of maternal healthcare services has led to a significant progress in maternal health, as evident in the reduction of maternal mortality ratio from 342 to 211 deaths per 100 000 live births from 2000 to 2017 worldwide.…”

Bayesian Analysis of Trends in Utilization of Maternal Healthcare Services in Pakistan during 2006-2018

“…There are few interesting studies regarding the investigation of trends in delivery of maternal healthcare in developing counties such as for India [ 13 ], China [ 14 ], Ethiopia [ 15 ], and Cambodia [ 16 ]. However, there is a dearth of such studies in Pakistan.…”

Maternal mortality ratio in China from 1990 to 2019: trends, causes and correlations

“…The NMMSS has rigorous quality control mechanisms, including data audits, regular supervision, and standardization of data collection methods. Data on live births and maternal death are collected annually by trained officials and verified by government administrators before being included in the China Health Statistics Yearbooks [ 24 ].…”

“…Although several studies have investigated the MMR in China, these studies were limited to certain areas [21][22][23] or short periods of time [24][25][26]. Further, there was a lack of research on the correlation between MMR and health financing composition.…”